Single port instruments

ABSTRACT

Surgical tools that can be used in single port laparoscopic procedures can include a low-profile handle assembly to minimize tool interference adjacent the incision site. For example, a handle assembly for a surgical instrument can have a generally in-line configuration extending linearly along a central longitudinal axis of an elongate shaft of the instrument. A linkage mechanism including a trigger, an actuation link, and an actuation shaft can be positioned within the in-line handle. The linkage mechanism can be pivoted between an open position in which end effectors of the instrument are open and a toggle position in which the end effectors are locked closed. A locking mechanism such as a ratchet mechanism can also be used to lock the end effectors. A surgical dissector can include gripping jaws having a curved profile or an angled elongate shaft to minimize tool interference and maximize visibility within a procedure site.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/834,137, entitled “SINGLE PORT INSTRUMENTS,” filed Aug. 24, 2015,which issued as U.S. Pat. No. 10,420,576, which is a continuation ofU.S. patent application Ser. No. 12/902,039, entitled “SINGLE PORTINSTRUMENTS,” filed Oct. 11, 2010, which issued as U.S. Pat. No.9,113,939, which claims the benefit of U.S. Provisional PatentApplication No. 61/250,411, entitled “SINGLE PORT INSTRUMENTS,” filedOct. 9, 2009. The above-referenced applications are each incorporated byreference herein in their entireties.

BACKGROUND OF THE INVENTION Field of the Invention

The present application relates to devices for use in general orlaparoscopic surgery, and, more particularly, to surgical devices usefulin single port surgeries.

Description of the Related Art

Various single port surgical procedures can be performed using a singleincision in the body of the patient and passing all instruments usedduring the surgery through that incision. While a single, relativelysmall incision site has various advantages for the patient, the singleaccess port can often lead to difficulty in handling of the instruments.With a single incision site, the handles of various surgical instrumentscompete for the limited space outside of the incision, and the elongatedinstrument shafts are positioned almost parallel to each other in alimited space inside the incision. This substantially parallelinstrument shaft configuration often leads to limited visibility of thesurgical site as the laparoscope is positioned along the otherinstrument shafts, limiting the angle in which the tips of theinstruments are visible. The novel devices described herein are designedto ease the restrictions posed by single port surgeries and make iteasier for the operating surgeon to perform the surgery.

SUMMARY OF THE INVENTION

In some embodiments, a surgical instrument is provided comprising ahandle assembly, an elongate shaft, and an end effector assembly. Thehandle assembly has a proximal end and a distal end. The elongate shaftextends from the distal end of the handle assembly along a centrallongitudinal axis. The elongate shaft has a distal end opposite thehandle assembly. The end effector assembly is disposed at the distal endof the elongate shaft. The handle assembly has an in-line configurationextending generally linearly from the proximal end to the distal endthereof. The handle assembly further comprises a handle body and alinkage mechanism. The linkage mechanism comprises a trigger, anactuation link, and an actuation shaft. The trigger is pivotably coupledto the handle body. The trigger is pivotable between an open position inwhich the end effector assembly is in an open state, and a toggleposition in which the end effector assembly is locked in a closed state.The actuation link is pivotably coupled to the trigger and extendsgenerally proximally within the handle body. The actuation shaft ispivotably coupled to the actuation link and longitudinally slidable withrespect to the elongate shaft responsive to pivotal movement of thetrigger.

In certain embodiments, a surgical instrument is provided comprising ahandle assembly, an elongate shaft, an end effector assembly, a firstrotation mechanism, and a second rotation mechanism. The handle assemblyhas a proximal end and a distal end. The elongate shaft extends from thedistal end of the handle assembly. The elongate shaft has a proximal endand a distal end. The elongate shaft comprises a proximal segment, anangled segment, and a distal segment. The proximal segment extends fromthe proximal end of the elongate shaft along a central longitudinalaxis. The angled segment is between the proximal end and the distal endof the elongate shaft. The angled segment has a bend angle. The distalsegment extends transversely to the central longitudinal axis by thebend angle from the angled segment to the distal end of the elongateshaft. The end effector assembly is disposed at the distal end of theelongate shaft. The first rotation mechanism has a first actuatorrotatably coupling the end effector to the elongate shaft. The secondrotation mechanism has a second actuator rotatably coupling the elongateshaft to the handle assembly. The handle assembly has an in-lineconfiguration extending generally linearly from the proximal end to thedistal end thereof.

In certain embodiments, a surgical instrument is provided comprising ahandle assembly, an elongate shaft, and an end effector assembly. Theelongate shaft extends distally from the handle assembly and defines acentral longitudinal axis. The end effector assembly comprises a pair ofjaws. The pair of jaws is operably coupled to the elongate shaft. Eachof the jaws has a proximal end coupled to the elongate shaft and adistal end opposite the proximal end. Each of the jaws comprises acurved profile between the proximal end and the distal end defined by anangular arc length of at least 35 degrees and an offset distance fromthe central longitudinal axis of at least 0.3 inches.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of an embodiment of surgical instrument having alow-profile handle assembly;

FIG. 2A is a top view of a jaw assembly of an embodiment of surgicaldissector having a curved jaw configuration;

FIG. 2B is a perspective view of the jaw assembly of FIG. 2A;

FIG. 3 is a cut away top view of the low profile handle assembly of FIG.1 with a linkage mechanism in an open position;

FIG. 4 is a cut away top view of the low profile handle assembly of FIG.1 with the linkage mechanism in a toggle position;

FIG. 5 is a top view of various embodiments of jaw assembly for asurgical instrument having various curved jaw profiles;

FIG. 6 is a top view of an angled shaft and jaw assembly for a surgicalinstrument having an independently rotatable jaw assembly;

FIG. 7 is a partial cut away view of a handle assembly for the surgicalinstrument of FIG. 6 ;

FIG. 8 is a partial cut away view of an embodiment of handle assemblyhaving a constant force spring for a surgical instrument;

FIG. 9A is a partial cut away view of an embodiment of handle assemblyhaving a ratchet mechanism for a surgical instrument;

FIG. 9B is a partial cut away view of another embodiment of handleassembly for a surgical instrument;

FIG. 9C is a partial cut away view of another embodiment of handleassembly for a surgical instrument;

FIG. 9D is a partial cut away view of another embodiment of handleassembly having a ratchet mechanism for a surgical instrument;

FIG. 10 is a partial cut away view of a handle assembly having a pinslot linkage mechanism for a surgical instrument; and

FIG. 11 is a partial cut away view of a handle assembly having ahydraulic actuation mechanism for a surgical instrument.

DETAILED DESCRIPTION OF THE INVENTION

With reference to FIG. 1 , an embodiment of surgical instrument 10 thatcan be used in single port surgical procedures is illustrated. Thesurgical instrument 10 comprises a handle assembly 12, an elongate shaft14 extending from a distal end of the handle assembly 12, and an endeffector assembly 16 coupled to a distal end of the elongate shaft. Invarious embodiments of surgical instrument, the end effector assembly 16can comprise grasping jaws, dissecting jaws, or cutting scissors oranother surgical tool. In some embodiments, the surgical instrument 10can include an electrical connector 11 electrically coupled to the endeffector assembly 16, wherein the end effector assembly 16 includes anelectrosurgical tool.

In some embodiments, the elongate shaft 14 and end effector assembly 16can be sized to pas through an access port such as a trocar cannulahaving a predetermined size. For example, the surgical instruments 10described herein can be sized for use in conjunction with a 5 mm trocarcannula, a 10 mm trocar cannula, a 12 mm trocar cannula, a 15 mm trocarcannula, or another trocar cannula size.

In some embodiments, the handle assembly 12 has a low-profileconfiguration extending generally longitudinally with respect to alongitudinal axis defined by the elongate shaft 14 of the surgicalinstrument 10 in an in-line configuration. In some embodiments, thehandle assembly 12 can extend generally longitudinally with a curvedergonomic grip portion (FIGS. 9A-9D) to facilitate user gripability andfurther enhance user comfort. Advantageously, the low-profile handleminimizes the size of the instrument extending proximally from theincision site, thus reducing the incidence of interference with othersurgical tools adjacent the incision site.

With reference to FIGS. 2A and 2B, one embodiment of end effectorassembly 16 with dissector jaws 18 having a curved profile isillustrated. Advantageously, the curved profile of the dissector jaws 18allows the end effector assembly to grasp tissue offset from othersurgical instruments inserted through a single insertion site. The jawswith the curved profile can move the distal end of the device off thecenterline of the elongate shaft and improve the visualization of thedistal end. The curve of the distal end also improves access to thetissue structures that are positioned behind other body formations.

In some embodiments, the curved profile can define an angular arc ofabout 60 degrees. Desirably, the curved profile can define an angulararc of greater than about 35 degrees. In other embodiments, the curvedprofile can define an angular arc of between about 35 degrees and about110 degrees, desirably, the curved profile can define an angular arc ofbetween about 45 degrees and about 95 degrees, and more desirably, thecurved profile can define an angular arc of between about 55 degrees andabout 65 degrees.

With reference to FIGS. 3 and 4 , the opening and closing of the endeffector assembly 16 of the device 10 can be accomplished by alternatelypushing a shuttle-like trigger 20 from one side of the handle assembly12 to the other. In some embodiments, a handle body 22 of the handleassembly 12 can include a first aperture 112 and a second aperture 114generally diametrically opposed to the first aperture 112. The trigger20 can comprise a first actuation surface 122 and a second actuationsurface 124 opposite the first actuation surface. A pivot such as apivot pin can couple the trigger 20 to the handle body 22 at a pointbetween the first actuation surface 122 and the second actuation surface124. With the trigger in a first, or open position, the first actuationsurface 122 can extend out of and protrude from the first aperture 112,as illustrated in FIG. 3 . With the trigger in a second, or toggleposition, the second actuation surface 124 can extend out of andprotrude from the second aperture 114, as illustrated in FIG. 4 .

With continued reference to FIGS. 3 and 4 , in some embodiments, theinstrument 10 can comprise a rotation mechanism rotatably coupling theend effector assembly 16 to the handle assembly 12. In some embodiments,the handle assembly 12 can include a rotatable knob 17 that is coupledto the elongate shaft 14 and can be used to rotate the elongate shaft 14and the end effector assembly 16 about the central longitudinal axis ofthe elongate shaft 14. In the illustrated embodiment, the rotatable knob17 is disposed at the distal end of the handle assembly 12. In someembodiments, the rotatable knob 17 and the elongate shaft 14 arerotatable 360 degrees with respect to the handle assembly 12. In otherembodiments, the handle assembly 12 can include stops to define therotatable motion of the rotatable knob 17 and the elongate shaft to anangular range less than 360 degrees. In some embodiments, as describedfurther herein, the handle assembly can include an additional rotationmechanism to rotate the end effector assembly 16 up to 360 degreesindependently with respect to the elongate shaft 14 as well.

In some embodiments, the handle of the laparoscopic surgical instrument10 can be symmetrical, which would allow for the rotation of the endeffector assembly 16 to be accomplished by the rotation of the handleassembly 12 itself. In other embodiments, the handle assembly 12 canhave a non-symmetrical ergonomic shape. With non-symmetrical handles,the surgical instrument can desirably include a rotatable knob asdescribed above such that rotation of the end effector assembly can beaccomplished by rotating the rotatable knob in the handle assembly. Thein-line, symmetrical, handle configuration allows for placement andmovement of two or more handles close to each other, without creatingundue handle interference due to their sizes. The handle can be rotated360 degrees in the palm of the user allowing for the comparable rotationof the distal end effector assembly 16, without using the rotating knob17. The rotating knob 17 can also be used for the same purpose, ifnecessary. In some embodiments, the shuttle trigger 20 design protrudesonly slightly outside of the low profile handle assembly 12, withouttaking much space and it is connected by the linkage mechanism to theactuating rod.

With continued reference to FIGS. 3 and 4 , the handle assembly 12 caninclude a linkage mechanism to actuate the end effector assembly. Thelinkage mechanism can be coupled to the handle body 22 of the handleassembly 12. As illustrated, the linkage mechanism comprises a trigger20, pivotably coupled to the handle body 22, an actuation link 24pivotably coupled to the trigger 20 at a first end of the actuation link24, and an actuation shaft 26 pivotably coupled to the actuation link 24at a second end of the actuation link 24. In the illustrated embodiment,the trigger 20 is pivotably coupled to the handle body 22 near a distalend of the handle body, the actuation link 24 is pivotably coupled tothe trigger proximal of the coupling between the trigger 20 and handlebody 22, and the actuation link 24 is pivotably coupled to the actuationshaft 26 proximal of the coupling between the trigger 20 and theactuation link 24. In other embodiments, the trigger, actuation link,and actuation shaft could have different geometries and arrangements tooperatively couple to the end effector assembly.

The actuation shaft 26 can be either a rigid member such as a metal or aplastic rod or tube, or a flexible member such as a wire or a cable.Movement of the trigger 20 to actuate the linkage mechanism between theopen position and the toggle position longitudinally slides theactuation shaft 26 with respect to the elongate shaft 14. The actuationshaft 26 can extend at least partially within the elongate shaft 14 andcan be operatively coupled to the end effector assembly 16.

FIG. 3 illustrates the linkage mechanism in an open position such thatthe end effector assembly 16 is open (e.g., jaws of a grasper or bladesof scissors are spaced apart from one another). FIG. 4 illustrates thelinkage mechanism in a toggle position such that the end effectorassembly 16 is closed (e.g., jaws of a grasper or blades of scissors arecontacting one another). With the linkage mechanism in the toggleposition, movement of the trigger 20 pivots the actuation link 24 into atoggle position to lock the end effector assembly 16 in the closedposition. Thus, advantageously, the linkage mechanism described hereincan include a locking mechanism that can be used to prevent the endeffector assembly 16 from opening inadvertently.

An advantage of the illustrated linkage mechanism design is that thesame shuttle trigger 20 can be used to close/open as well as tolock/unlock the end effector assembly 16 of the device. The lock isactivated by actuating the shuttle trigger 20, closing the end effectorassembly 16 on the tissue, and exerting the additional pressure on thetrigger 20 to push the connected linkage over the centerline of thedevice, moving the linkage mechanism into the toggle position. Thelinkage or shaft deformation can be utilized to limit end effectorassembly pressure exerted during the toggle creation. The end effectorassembly 16 can be opened again by pushing the shuttle trigger in theopposite direction. As discussed in greater detail with reference toFIG. 9 , in some embodiments, an additional or separate lockingmechanism can be positioned in the handle assembly.

Advantageously, with a surgical instrument having a low-profile handleand linkage mechanism as illustrated in FIGS. 1, 3, and 4 , a medicalpractitioner is provided with relatively free and unrestricted movementof the handles proximal to the surgical incision and good tip visibilityat the surgical site distal to the surgical incision. These advantagesare particularly evident in surgical procedures with limited spacewithin the operation site such as procedures that utilize a singleaccess port.

With reference to FIG. 5 , in some embodiments of surgical device havingend effector assemblies 16 with jaws, the jaws can be manufactured withdifferent size curves and/or with different lengths. For example, asdiscussed above with reference to FIG. 2 , the angle of curvature of thejaws with reference to the elongate shaft can include an arcuate profilebetween about 35 degrees and about 110 degrees, desirably, the curvedprofile can define an angular arc of between about 45 degrees and about95 degrees, and more desirably, the curved profile can define an angulararc of between about 55 degrees and about 65 degrees. Moreover, in theillustrated embodiments, an offset distance, L1, L2, L3, L4 between atip of the jaws and a central longitudinal axis, A of the elongate shaftof the surgical instrument can range between approximately 0.457 inchesand approximately 0.763 inches. In certain embodiments, the offsetdistance can be at least approximately 0.3 inches. In some embodiments,the offset distance can be between approximately 0.3 inches and 1.0inches, desirably, the offset distance can be between approximately 0.45inches and 0.85 inches, and more desirably, the offset distance can bebetween 0.55 inches and 0.70 inches. Tip visualization and access to thetissue structures can be optimized by varying the curved profile andoffset distance of jaws of an end effector assembly.

With reference to FIG. 6 , in some embodiments, the elongate shaft 14′can comprise an angled segment 40 that would allow for better tipvisualization and improved access to the tissue structures that arepositioned behind other body formations. Thus, the elongate shaft 14′can comprise a proximal segment 132 extending from a proximal end of theelongate shaft along a central longitudinal axis, an angled segment 40between the proximal end and the distal end of the elongate shaft, and adistal segment 134 extending transversely to the central longitudinalaxis from the angled segment to the distal end of the elongate shaft.The angled segment 40 has a bend angle defining the transverserelationship of the distal segment 134 to the central longitudinal axis.In some embodiments, the bend angle can be greater than about 20degrees. In some embodiments, the bend angle can be between about 20degrees and about 45 degrees.

With continued reference to FIG. 6 , advantageously, a surgicalinstrument having an angled elongate shaft 14′ can be used in a singleport procedure in conjunction with another surgical instrument having astraight elongate shaft 14 such that a surgeon can position the endeffector assemblies of the instruments in close proximity to one anotherwhile the handle assemblies of the instruments are spaced apart from oneanother to facilitate manipulation of the surgical instruments.

With reference to FIG. 7 , an embodiment of handle assembly 12 that canbe used with the angled elongate shaft 14′ of FIG. 6 is illustrated. Thehandle assembly 12 can include a first rotation mechanism rotatablycoupling the end effector assembly 16 to the elongate shaft 14′ and asecond rotation mechanism rotatably coupling the elongate shaft 14′ tothe handle assembly 12. In the illustrated embodiment, the handleassembly 12 includes a first rotation mechanism having a rotatableactuator such as a rotatable knob 17 positioned between the proximal endand the distal end of the handle assembly 12 and rotatably coupled tothe handle assembly. As illustrated, rotatable knob 17 rotates aclevis/jaw assembly within the angled shaft 14′ to rotate the endeffector assembly 16 relative to the shaft 14′. In some embodiments, theend effector assembly can be rotated 360 degrees relative to theelongate shaft 14′ using rotatable knob 17. In other embodiments,rotation of the end effector assembly relative to the elongate shaft 14′can be restricted to a predetermined angular range.

With continued reference to FIG. 7 , as illustrated, the handle assembly12 also includes a second rotation mechanism having a rotatable knob 27positioned at the distal end of the handle assembly 12 and rotatablycoupled to the handle assembly 12. The rotatable knob 27 rotates theangled elongate shaft 14′ relative to the handle assembly 12. In someembodiments, the elongate shaft 14′ can be rotated and fixed atpredetermined stops in predetermined angular increments, such as, forexample 180 degree angle increments. Thus, the second rotation mechanismcan be rotated to a first position at a first predetermined stop thatpositions the angled elongate shaft 14′ such that the surgicalinstrument can be used in a surgeon's right hand while anotherinstrument is in the surgeon's left hand. The second rotation mechanismcan be selectively rotated to a second position at a secondpredetermined stop rotationally 180 degrees angularly spaced from thefirst predetermined stop that positions the angled elongate shaft 14′such that the surgical instrument can be used in a surgeon's left handwhile another instrument is in the surgeon's right hand. In otherembodiments, the predetermined stops can be arranged as desired indifferent angular spacings. For example, in some embodiments, a secondrotation mechanism can have four predetermined stops, angularly spaced90 degrees apart from one other to define an orientation of the elongateshaft 14′ for right handed operation, an orientation of the elongateshaft 14′ for left handed orientation, an orientation of the elongateshaft 14′ allowing positioning above another surgical instrument, and anorientation of the elongate shaft 14′ allowing positioning below anothersurgical instrument.

With continued reference to FIG. 7 , in some embodiments, thepredetermined stops of the second rotation mechanism are defined byselectively engageable features formed on the rotatable knob 27 and thehandle assembly 12. The rotatable knob 27 can comprise a latch member127 coupled thereto which is engageable with one or more recesses, suchas detents 129 formed at the distal end of the handle assembly to definea predetermined stop.

With continued reference to FIG. 7 , in some embodiments, the handleassembly 12 can include an electrical connector 11′ that is recessedinto the body of the handle. As illustrated, an electrical connectionpin does not extend distally beyond a distal end of the handle assembly,and the electrical connection pin is positioned within a recess in thebody of the handle. Advantageously, such a recessed electrical connector11′ can enhance user safety when working with electrosurgical devices.Also, advantageously, the recessed electrical connector 11′ can enhancethe low profile configuration of the handle assembly, reducing the riskof collisions between the electrical connector and hands or fingers ofmedical practitioners or collisions with other surgical instruments atthe surgical site.

With reference to FIG. 8 , an embodiment of handle assembly for surgicalinstrument is illustrated. The end effector assembly of the surgicalinstrument can be locked in place upon placing trigger 20 and thelinkage mechanism in the toggle position as described above withreference to FIGS. 3 and 4 . In the embodiment of FIG. 8 , the linkagemechanism includes a spring 60 that can be placed between the actuationshaft 26 and the actuation linkage 24, facilitating the toggle positioncreation. The spring 60 would compress (or extend) when the tension orcompression forces reach a predetermined value, associated with thespring rate, limiting the jaw's clamping force and establishing theforce required to place the linkage in the toggle position. For example,once the shaft pulling force reaches predetermined amount (i.e. 70 lbs),the spring starts compressing (or extending), limiting amount of forceapplied to the jaws. Any additional linkage and trigger movementstretches (or compresses) the spring only, without applying more forceto the actuating rod. Thus, advantageously, a predetermined constantforce can be applied to tissue retained by the end effector assembly 16using the illustrated linkage mechanism. Once the linkage is pushed overthe actuating rod's centerline, the linkage is in the toggle position,preventing the jaws from opening. Pressing on the shuttle trigger 20 inthe opposite direction, stretches (or compresses) the spring 60 again,which allows the linkage to be pushed back over the rod's centerline,releasing the end effector assembly 16.

With reference to FIGS. 9A and 9D, in some embodiments of handleassembly 12′, instead of or in addition to using the toggle mechanismdescribed above to lock the end effector assembly 16 in a closedposition, a shuttle trigger ratchet mechanism 70 on the linkagemechanism can be used to lock the end effector assembly 16. The ratchetmechanism 70 comprises a ratchet 72 having at least one latched positionthat can prevent the shuttle trigger 20 from moving towards an openposition with respect to the handle assembly 12, preventing movement ofthe linked actuation shaft 26 and locking the jaws or other endeffector. The ratchet mechanism 70 is movable to a free position inwhich the trigger 20 can be moved freely towards the open or closedposition. The ratchet 72 of the ratchet mechanism can comprise one ormore teeth positioned on the handle body. A corresponding spring loadedpawl 74 can be positioned on the shuttle trigger 20. The pawl 74 can beconfigured to engage the teeth of the ratchet 72, defining the one ormore latched positions. As illustrated, the ratchet 72 has multipleteeth, allowing incremental latched positions between a fully open and afully closed end effector assembly.

With continued reference to FIGS. 9A and 9D, the pawl 74 can beoperatively coupled to a release button 76, 76′ positioned on thetrigger 20. By pressing the release button 76, 76′, the pawl 74 is movedaway from the ratchet 72 teeth, allowing for free movement of thetrigger 20. For example, with the ratchet mechanism 70 in a latchedposition, the release button 76, 76′ can be pressed to allow movement ofthe trigger 20 to the open position. Moreover, in some instances, it canbe desirable to allow free movement of the trigger from the openposition to the closed position without the spring loaded pawl engagingthe ratchet. Thus, the release button 76, 76′ can be pressed duringactuation of the trigger towards a closed position. If desired, thepressure on the release button can be removed to engage the ratchetduring such a closing actuation.

With continued reference to FIGS. 9A and 9D, desirably, the releasebutton 76, 76′ can be positioned on an actuation surface of the trigger20. In the illustrated embodiment, the release button 76 is positionedon a second or upper actuation surface of the shuttle trigger 20. Asillustrated, a user will naturally press the upper actuation surface tomove the trigger 20 towards an open configuration. Thus, advantageously,this placement of the release button 76, 76′ facilitates release of theratchet mechanism to a free position when it is desired to open the endeffector assembly. The release button 76, 76′ can be biased such thatthe pawl 74 is biased towards engagement with the ratchet 72 teeth. Forexample, a biasing member such as a coil spring 78, 78′ can bear on thetrigger 20 and the release button 76, 76′ to urge the pawl 74 intoengagement with the ratchet 72 teeth.

Various assemblies can be used to couple the release button 76, 76′ tothe trigger 20 at the upper actuation surface to allow thisdisengagement. For example, in the embodiments of handle assembly 12′illustrated in FIG. 9A, the release button 76 is slidably coupled to thetrigger 20. The illustrated slidable coupling includes posts or pinscoupled to the trigger 20 sliding in slots formed in the release button76, although in other embodiments, other sliding assemblies arecontemplated. In the embodiment of handle assembly 12′ illustrated inFIG. 9D, the release button 76 is pivotably coupled to the trigger 20about a pivot point at a distal corner of the upper actuation surface ofthe trigger 20.

With reference to FIGS. 9A-9D, in certain embodiments of surgicalinstrument, the handle assembly 12′, while extending generallylongitudinally, can include a curved grip portion to enhance theergonomic experience to a user without substantially diminishing theability of multiple surgical instruments to be positioned within asingle surgical port. Thus, advantageously, in some embodiments, thehandle assembly 12′ can be slightly asymmetric, providing improvedcomfort to the user, without any substantial size increase. Moreover,various features discussed herein with respect to certain embodiments ofthe surgical instruments can be combined in various embodiments ofhandle assembly. For example, FIG. 9B illustrates a handle assembly 12′with no ratchet mechanism and FIG. 9C illustrates a handle assembly 12′with no ratchet mechanism for use with an angled elongate shaft havingtwo rotation mechanisms and two corresponding rotatable knobs 17, 27,similar to those discussed above with respect to FIG. 7 as certainsurgical instruments, for example, scissors and dissectors can beeffective without the use of a ratchet, while other instruments, forexample, graspers can advantageously include a ratchet mechanism. In theembodiments of FIGS. 9B and 9C, the handle assembly 12′ includes ratchetteeth to provide manufacturing efficiencies and commonality of partswith other surgical instruments including ratchet mechanisms. In otherembodiments of surgical instruments without a ratchet mechanism, thehandle assembly can be free of ratchet teeth. FIG. 9D illustrates ahandle assembly 12′ having an ergonomic curved grip portion, a ratchetmechanism 70, and no electrical connector. It is contemplated thatvarious other combinations of the features discussed herein can be madein various other embodiments of surgical instruments within the scope ofthe present application.

With reference to FIGS. 9A and 9B in certain embodiments, electricalcoupling of the electrical connector 11′ to the actuation shaft 26 cancomprise an electrically conductive member such as an electricallyconductive wire 15 or an electrically conductive spring 15′. In someembodiments, the electrically conductive member electrically contactsthe electrical connector 11′ and the actuation rod 26 and is sized tomaintain electrical contact with the electrical connector 11′ and theactuation rod 26 throughout an actuation cycle of the actuation rod 26from an open position of the end effector assembly to a closed positionof the end effector assembly.

With reference to FIG. 10 , another embodiment of handle assembly havinga linkage mechanism is illustrated. In the illustrated embodiment, theopening and closing of the end effector assembly of the instrument canbe accomplished by means of a slotted trigger 20′ and a pin 80 connectedto the actuation shaft 26 of the device. The pin 80 travels inside andis constrained by the slot 82 in the trigger 20. By pressing the shuttletrigger 20 in either direction, the pin 80 and the connected actuationshaft 26 follows the profile of the slot in the trigger 20, opening andclosing the end effector assembly of the instrument.

With reference to FIG. 11 , in some embodiments, the opening and closingof the end effector assembly 16 of a surgical instrument can beaccomplished by means of hydraulic action provided by an incompressiblefluid 100 such as saline, mineral oil, or a gel. The fluid can be storedinside the handle 90 and moved by pulling a small diameter piston 92coupled with a movable handle 102. The pressure created by the fluidmovement would push a large diameter piston connected to the actuationshaft, which is connected to the jaws of the instrument, causing thejaws to close. The hydraulic circuit can be sealed at appropriatelocations with gaskets or other seals 104 such as O-rings. Theincompressible fluid can be used to generate a high tensile force on theactuation shaft with a minimal user input force. The force multiplier inthe handle is equal to the ratio of the areas of the pistons. Thehydraulic action enables the handle to deliver the appropriate jawactuation force and to be designed in a small compact configuration tofit in the palm of a surgeon's hand. The handle could also be designedto push the actuation rod to close the instrument jaws. The handle couldalso include a compression spring 106 to return the instrument jaws toan open configuration.

In some embodiments, a smoke evacuation channel/path can be added to theinstrument design. A connector can be added to the handle to which avacuum line can be attached. The connector can be placed onto a handleor on top of the shaft. The smoke generated during electrosurgery canthen be drawn inside the instrument shaft and out through the connectorin the shaft or in the handle. The instruments could alternativelyinclude a vent cap with a manual valve to enable smoke generated duringelectrosurgery to be vented though the shaft.

During clinical use, an access device such as a trocar or Gelpoint™ isfirst placed through a body wall creating an opening across the bodywall. The instrument is then inserted through the seal of the accessdevice until the distal end of the instrument extends beyond the bodywall opening and positioned adjacent to the operating site. Thegrasper/dissector jaws or scissors are then used to manipulate or cuttissue by pressing on the shuttle trigger.

In some embodiments, a method of manufacture of the novel instruments isinjection molding of the plastic components and machining or casting ofthe metal components.

Although this application discloses certain preferred embodiments andexamples, it will be understood by those skilled in the art that thepresent inventions extend beyond the specifically disclosed embodimentsto other alternative embodiments and/or uses of the invention andobvious modifications and equivalents thereof. Further, the variousfeatures of these inventions can be used alone, or in combination withother features of these inventions other than as expressly describedabove. Thus, it is intended that the scope of the present inventionsherein disclosed should not be limited by the particular disclosedembodiments described above, but should be determined only by a fairreading of the claims which follow.

What is claimed is:
 1. A surgical instrument comprising: a handleassembly having a proximal end and a distal end; an elongate shaftextending from the distal end of the handle assembly along a centrallongitudinal axis, the elongate shaft having a distal end opposite thehandle assembly; and an end effector assembly disposed at the distal endof the elongate shaft; wherein the handle assembly further comprises: ahandle body comprising an exterior surface, a first aperture formed inthe exterior surface and a second aperture formed in the exteriorsurface and diametrically opposed to the first aperture; and a linkagemechanism comprising: a trigger pivotably coupled to the handle bodynear the distal end of the handle assembly, the trigger comprising afirst end extendable from the first aperture and a second end extendablefrom the second aperture, the trigger being pivotable between an openposition in which the first end extends from the first aperture and theend effector assembly is in an open state, and a closed position inwhich the second end extends from the second aperture and the endeffector assembly is in a closed state; an actuation link pivotablycoupled to the trigger between the first end and the second end andextending generally proximally within the handle body; an actuationshaft pivotably coupled to the actuation link proximal of the couplingof the actuation link with the trigger, the actuation shaft beinglongitudinally slidable with respect to the elongate shaft responsive topivotal movement of the trigger; and a ratchet mechanism to selectivelylatch the trigger to the handle body.
 2. The surgical instrument ofclaim 1, wherein the ratchet mechanism comprises a plurality of teethpositioned in the handle body.
 3. The surgical instrument of claim 2,wherein the plurality of teeth is positioned adjacent the secondaperture in the handle body.
 4. The surgical instrument of claim 2,wherein the ratchet mechanism comprises a pawl positioned on thetrigger.
 5. The surgical instrument of claim 4, wherein the ratchetmechanism further comprises a release button coupled to the pawl.
 6. Thesurgical instrument of claim 5, wherein the release button is positionedat the second end of the trigger.
 7. The surgical instrument of claim 6,wherein the release button is positioned to unlatch the ratchetmechanism when the trigger is moved from the closed position towardsopen position.
 8. The surgical instrument of claim 1, wherein theratchet mechanism has at least one latched position.
 9. The surgicalinstrument of claim 8, wherein the ratchet mechanism has a plurality ofincremental latched positions between the open state and the closedstate of the end effector assembly.
 10. A surgical instrumentcomprising: a handle assembly having a proximal end and a distal end; anelongate shaft extending from the distal end of the handle assemblyalong a central longitudinal axis, the elongate shaft having a distalend opposite the handle assembly; and an end effector assembly disposedat the distal end of the elongate shaft; wherein the handle assemblyextends generally linearly from the proximal end to the distal endthereof; and wherein the handle assembly further comprises: a handlebody having an outer surface and comprising a first aperture in theouter surface and a second aperture in the outer surface opposite thefirst aperture; and a linkage mechanism comprising: a shuttle pivotablycoupled to the handle body near the distal end of the handle assemblyand extending across the handle body between the first aperture and thesecond aperture, the shuttle comprising a first surface extendable fromthe first aperture of the handle body and a second surface extendablefrom the second aperture and pivotable between a first position in whichthe first surface protrudes from the first aperture and a secondposition in which the second surface protrudes from the second aperture,wherein movement of the shuttle between the first position and thesecond position actuates the end effector assembly; and a ratchetmechanism to selectively lock the shuttle to the handle body.
 11. Thesurgical instrument of claim 10, wherein the second surface of theshuttle comprises a release button for the ratchet mechanism toselectively unlock the shuttle from the handle body.
 12. The surgicalinstrument of claim 10, further comprising an electrical connectorrecessed into the handle body.
 13. The surgical instrument of claim 12,wherein the linkage mechanism comprises an actuation shaft operablycoupled to the shuttle and the end effector and further comprising oneof an electrically conductive spring and an electrically conductive wireelectrically coupling the electrical connector to the actuation shaft.